Lights and Sirens
by Cass Purser
Summary: A self-indulgent AU where Ryuuko and Satsuki are paramedics. Will be ongoing.
1. Chapter 1

The sun was shining, the birds were chirping, and Ryuuko Matoi was enjoying the morning drive with her windows down and a large coffee in hand. Her car purred as she accelerated, enjoying how smooth the ride was compared to her old shitbucket she was driving not even a week prior. "And this stereo…" she muttered to herself with a grin, cranking the tunes just in time to belt out her favourite verse of the song.

_Late night, brakes lock, hear the tires squeal;_

_Late night, can't stop, so I spin the wheel._

_My world goes black before I feel an angel steal me from the;_

_Greedy jaws of death and chance!_

_And pull me in with steady hands!_

_Giving me a second chance!_

_THE ARTIST IN THE AMBULANCE!_

She screamed the last line, slamming her palm against the smooth leather steering wheel. Today, Ryuuko Matoi was working as a paramedic for the first time. She had spent the last two years getting her certification, working her ass off to impress her preceptors while on her ambulance placement. She must have done something right, because she was the only student in her class to be offered a position before she had even technically graduated. She was offered a contract as a part time medic, working out of the same base for two months while another medic was finishing up her pregnancy leave. She was well aware that the pressure was on, she knew that the service would be unofficially inquiring to her partner about her performance once the contract was up.

She pulled into the parking lot, juggling her equipment bag, backpack, lunch, and a large coffee as she made her way to the door. She muttered a curse through the coffee she was carrying by her teeth, realizing that she needed to free a hand to grab her fob on her keys to unlock the door. But before she could drop a bag, a pale hand reached out and unlocked the door for her.

"Let me give you a hand with that." A voice said, and Ryuuko turned to see another medic standing behind her. The woman had long black hair braided back and lips that were trying to be serious but betrayed the slightest hint of amusement. Ryuuko swallowed dryly, mentally telling the hormones surging through her body to calm the fuck down because this woman was to be her partner for the next two months. The woman reached out and took the coffee from Ryuuko.

"Thank you," Ryuuko said gratefully, hitting the handicapped button and stepping back to allow the woman in the door first. "My name is Ryuuko, by the way."

"Satsuki." Satsuki replied as they walked down the hallway to the crew room. "Let's get our truck check over with first, then we can sit down and meet eachother properly."

Ryuuko followed the woman into the garage, the night crew stepping out of the vehicle with tired expressions.

"I think we got all of your calls last night too, Satsuki." The one medic groaned, his hand sweeping his green hair out of his eyes. "We got absolutely hammered. I don't know what I did to piss off dispatch, but someone needs to tell Inumuta that it's not cool to dispatch us on two priority ones back to back."

"Anything good, Sanageyama?" Satsuki inquired, hooking the cardiac monitor up to the text box and testing that the monitor would shock at the appropriate number of joules. Ryuuko busied herself by looking though the bags, pulling out the stock binder to make sure the appropriate number of supplies were in the bags.

"Pede VSA." A deep voice grunted from in the cab of the truck. Ryuuko swallowed, a child that was vital signs absent was just about every medic's worst fear. No one wanted to do CPR on a child.

"Shit. How did it go?" Satsuki looked at Uzu with a concerned expression. Uzu smiled, throwing his hands up in the air.

"ROSC, baby!" he crowed. "Gama got that return of spontaneous circulation just as we were pulling into the parking lot of the General. The kid just happened to switch to a shockable rhythm at the last second, and came back with one shock. So unreal."

Ryuuko listened to the banter with a grin, taking the night crew's good luck as a sign today would be a good day for her. To get a ROSC on a patient meant to save a life, something that didn't always happen everyday. Especially considering that the cardiac monitor could only shock two specific heart rhythms back into a normal "Sinus" rhythm, and when a heart was stopped it usually stayed stopped. And to get a ROSC on a paediatric… well that was something worth celebrating.

Ryuuko hopped out of the truck as the other medic came around, a hulking giant with blonde hair. "I'm Ryuuko." She introduced herself, shaking hands with both of the night crew. They introduced themselves in turn, as Uzu Sanageyama and Ira Gamagoori. After the minimum amount of polite conversation they both excused themselves, saying that they needed to get some sleep and they would be back at 6pm that night. The garage door slammed behind them, and the garage was quiet other than Satsuki doing the radio checks in the front of the truck.

"Ryuuko, can you get the back?" Satsuki called.

"Sure, one sec!" Ryuuko responded, climbing into the back and clearing her throat before picking up the black telephone.

"Honno dispatch, 2115 patient compartment radio check." She said clearly into the phone. There was a slight pause before dispatch responded, saying the transmission was received at full strength and they were just sending the test page to their base now. As they finished speaking a tone rang loudly in the garage, and the dispatcher stated their truck number and test page twice before hanging up.

"Alright, that should be everything." Satsuki said, appearing at the back bumper. "Do you have any questions about equipment or our bags?"

"Nah, I'm good." Ryuuko shrugged. "We went over everything in our orientation, and since we are a BLS truck, we have one less bag to worry about anyways." The fact that both Satsuki and Ryuuko were only Primary Care Paramedics rather than one of them being an Advanced Care medic made their truck a BLS truck – basic life support. If they needed to deliver advanced medication, intubate, or start an IV, they would need to call dispatch and request an ALS truck to the call from another base.

"Let's go to the crew room and talk then." Satsuki said, turning and walking to the door. Ryuuko clambered out of the truck and followed her, settling down on one of the black lazyboys and putting her feet up.

"Why don't I start?" Satsuki suggested. Ryuuko voiced her consent, happy to have a reason to stare at the beautiful woman without it being weird. _"Focus._" She chided herself silently.

Satsuki stared at the TV for a moment, pursing her lips in thought. "Well, my name is Satsuki Kiryuin." She began. "I'm twenty-five years old, and I've been a medic for six years here at HEMS."

Ryuuko blinked in surprise, not expecting Satsuki to be only a year older than her. "You must have started right out of high school then." She responded.

Satsuki met her eye with a slight smile. "Nobody ever expects me to be this young." She said with a faint hint of amusement. "I graduated high school when I was 17, because of my late birthday, and found a PCP program that began that summer. I finished school when I was 19, and was hired before even finishing my consolidation."

"Well, that sounds similar to myself." Ryuuko said. "I only finished my consolidation three weeks ago, and wrote the A-EMCA last week. Honno offered me a part time contract while I was still in my placement, and here I am." The A-EMCA was the paramedic test you needed to pass in order to work as a PCP, a challenging exam comprised of pathophysiology, pharmacology, relevant protocols and legal acts, and critical thinking questions that would stump any medic on scene. Her contract was pending her results – meaning that if she failed her A-EMCA twice she would lose her contract and her position as a medic until she could pass.

"Yes, I had heard that." Satsuki replied, turning her eyes back to the television. "Our supervisor approached me and asked if I was interested in taking an up and coming medic under my wing. I've never had much interest in teaching, but he assured me that you knew your stuff and that it would be beneficial for the both of us. Your preceptors said much of the same when I called them."

Ryuuko tried to suppress the smile that threatened to spread across her face. To be spoken of so highly, especially by the medics she had been paired with on her placement, was huge. "Well, I will do my best to live up to that expectation." She said neutrally, not wanting to come off as cocky. As she spoke the base tones rang, the dispatcher stating "2115, priority one – airway obstruction. 2115 priority one, South for details."

"Well, I guess we will see." Satsuki commented, getting up quickly and gathering her bag. The two of them climbed in their truck and took off, lights and sirens.

* * *

AN: And so, chapter one. I'm doing my best to keep the medical language simple without taking away from standard paramedic conversation. I'll be putting a list of any unfamiliar words or medications at the bottom of each chapter for quick reference. I love feedback!

Preceptors - a pair of paramedics that a student is assigned to for their placement. Generally senior medics, but not always.

Consolidation - ambulance placement

ALS - advanced life support. A crew with at least one ACP medic on board.

BLS - basic life support. A crew comprised of two PCPs

ACP - advanced care medic. Can do advanced procedures such as intubation, IV, and advanced medications

PCP - primary care paramedic. Can give basic symptom relief medication, like nitro, aspirin, salbutamol puffers, epinephrine, etc.

VSA - vital signs absent. A patient who is in cardiac and respiratory arrest. Dead.

ROSC - return of spontaneous circulation. At patient who was VSA who now has a pulse again.

Pede - paediatric, a child/baby

A-EMCA - the paramedic exam here in Ontario, Canada. Also in Honno, for the purposes of my little AU.


	2. Chapter 2

Satsuki closed the door to the truck, and beside her Ryuuko did the same. As she put the truck into gear and her fingers flipped the lights on with practiced ease, she glanced at Ryuuko's face and the expression of anxiety it displayed. She sympathized with the girl, having a hot call right off the bat as a new medic was enough to make anyone nervous. But she knew what she signed up for, and it was time to perform.

"Honno, 2115 on south." She said into the radio. There was a slight pause, then the dispatchers voice filled the enclosed space.

"2115, you are on a priority one to 25 Harbour Drive – that's 25 Harbour Drive – for an airway obstruction. Female patient, unknown age. Patient's family stated the patient was eating steak and began choking. We weren't able to get many other details from family, uncertain whether the obstruction is partial or full at this time. There is no ALS unit available at this time, but fire has been tiered to the call with you. More details as we receive them, over."

Satsuki keyed the mike deftly with a roger, indicating they received the transmission. Beside her, Ryuuko groaned. "Of course there is no ALS backup."

Satsuki kept her eyes on the road, confidently maneuvering around an old lady who stopped for them in the middle of the road rather than pulling over to the right. "We don't need them. We have our training to fall back on, and fire for an extra set of hands." She worked the sirens as she spoke, slowing down long enough to insure the intersection was at a stop before blowing the light. "I'll attend this call, and you support me. Let's walk through the plan of attack."

The girl was quiet for a moment, before responding with a determined tone. "Well, okay. If it's a partial obstruction: get her sitting down and calm on the stretcher, administer oxygen, and get the hell going. If it's a full obstruction and she's still conscious: one of us manages the obstruction with abdominal thrusts and black blows while the other prepares us to manage a VSA. And if it's a full obstruction and she is VSA – well that's easy. Get compressions going, keep an eye out for the steak before attempting to ventilate, one analyze on the monitor, then get the hell going."

Satsuki let out a hum of approval. "Exactly. We're going to get there, family is going to be panicking, the patient will be panicking, and fire is going to be looking to us for what to do. We are going to walk in, and be calm and in charge. We both have the same training, we know our directives, and we know what needs to be done." Her finger jabbed at the siren as a motorist pulled onto the road in front of them. "Keep the call moving forwards. I don't want you standing still and looking to me for commands. We are partners; I'm not your preceptor. If you see something that I forget or am missing, either say it or do it. I'll do the same." She glanced at Ryuuko, and allowed a comforting smile to spread across her face before turning her eyes back to the road. "If you find yourself shitting your pants, and everything that we need to do drops out of your head, I will always be there. And you will be there for me. We will work through the chaos of the scene together."

Ryuuko was quiet, but from the girls posture Satsuki could tell that her little pep talk had the desired effect. They pulled onto Harbour Drive, and pulled up beside the firetruck that had beat them to the scene. Satsuki put the truck into park, set the parking brake, and turned to her partner.

"Let's do this."

* * *

Satsuki's words echoed through Ryuuko's head as she walked along the side of the truck, pulling her gloves on. They met at the back of the truck and pulled the stretcher out, their bags and cardiac monitor strapped on it. A firefighter met them as they were walking up the driveway of the house.

"We've got a female patient with a partial obstruction in the backyard." The man said, hooking his thumbs in his suspenders. "She still seems to have decent air entry and good sats, we brought the husband inside because he was freaking out and making her panic. I've got a med list and healthcard here for you. I think her name was Susan."

"That's great, thank you." Satsuki said. Ryuuko stayed quiet, processing what she had been told and committing the details to memory.

"_Okay, so partial airway obstruction. She has a good oxygen saturation level, so she is obviously getting enough air entry to keep the oxygen circulating."_ Every call, her inner voice would monologue the information she obtained in order to properly analyze it and manage the problems at hand.

They rounded the corner of the house to see a middle aged woman sitting on a patio chair with a half eaten plate of steak and eggs in front of her. _"In moderate distress, but able to sit calmly and obey instructions. She's not fighting the NRB fire put on her. Face is ruddy, but lips aren't cyanosed. Good." _Blue lips and fingertips would indicate a deficit of oxygen – and a brain starved for oxygen usually made the patient uncooperative and panicked as her hypoxia increased. Those patients usually would not tolerate having the NRB – non-rebreather- oxygen mask on their face, even if oxygen was the one thing that they needed.

"Hello Susan, my name is Satsuki and this is Ryuuko." Satsuki said in a calming voice, kneeling in front of the patient and feeling a radial pulse on her wrist as she spoke. "I need you to stay nice and still for me and don't try to talk, just shake or nod to answer my questions. We don't want to disturb that steak or try to remove it, we're just going to do a couple tests then we are going to head out to the hospital. Do you understand?"

As Satsuki began her assessment, Ryuuko set the monitor on the ground and turned it on. She pulled out the electronic cuff and placed it on the patient's arm, and pulled out the small pulse oximetre and positioned it on the patient's finger while the cuff inflated. Behind her, the firefighter set up the stretcher for them by spreading out the sheet and lowering the siderail.

Ryuuko pulled out the ECG leads, placing the appropriate stickers on the patient's upper arms and shins. By that time the blood pressure was finished, so Ryuuko stopped for a moment and studied the monitor. "She's satting at 96%, BP's good and she is in a perfect sinus tach." She said to Satsuki. _"Slightly lower than normal saturation, to be expected. Pulse is a little tachy, a little high, but normal for this situation. Nothing really to panic about here."_

Satsuki pulled the earpieces of her stethoscope out of her ears and turned to Ryuuko. "I'm hearing good entry bilaterally, and some localized gurgling and stridor around the obstruction but nothing in the apices or bases themselves. Let's switch her over to our O2 and get going."

"_So air is able to get into her lungs on both sides, and other than the obstruction her lungs are clear. Good."_

Ryuuko turned to find the portable oxygen, and the firefighter was standing behind her holding it out to her. She thanked him and opened the tank, and unplugged the oxygen hose from Fire's tank onto theirs. She grabbed a replacement NRB from their bag and gave it to the firefighter so they didn't have to replenish their stock. Together, her and Satsuki helped the patient to her feet and had her take the two steps necessary to get her on the stretcher. They carefully loaded her, and Satsuki climbed into the back before Ryuuko shut the doors. Ryuuko went around to the side door and got in, immediately switching the oxygen over to the truck tank so their small portable tank wouldn't run dry. Two firefighters met her at the side door.

"Do you want one of us to come along?" the one asked.

"I think we are okay here guys. Thank you though." Satsuki responded as she hit the button to obtain another blood pressure. She turned her head to look at Ryuuko. "Let's go on a priority two. Try to watch the bumps, okay?"

"You got it." Ryuuko responded, and she climbed out the side door to the front of the cab. She climbed into the drivers seat and reached for the radio as she buckled herself in.

"Honno, call 2115."

The radio crackled to life. "Go ahead, 2115."

"2115, en route to Honno General on a priority two. We will be patching on this call."

"10-4 2115, let us know when you are ready for that patch."

"Roger." Ryuuko hung up the radio, and pulled carefully out of the patient's driveway. Her hand fumbled with the controls on the dash, before she found the appropriate switch and flicked the lights and sirens on. She allowed herself a grin as she watched cars pulling over for her._ "Artist in the ambulance." _She thought, still feeling slight awe at the fact that she's finally working as a paramedic after dreaming about it for so long.

She had just pulled onto the highway when Satsuki's voice rang out from in the back, the stress clear in her voice.

"I need you back here, Ryuuko. It's a full obstruction."

* * *

Such is life in ambulance.

NRB – non rebreather. Delivers almost 100% pure oxygen to the patient

Priority one, two, etc – categorizes how emergent the call is. Priority one is the highest, five is the lowest.

Sinus tach – a heart rhythm that is normal aside from being over 100bpm.

Pulse oximetre – little finger clamp that measures what percentage of haemoglobin has been bound to oxygen molecules. Gives you your oxygen saturation level

ECG leads – four wires on stickers, used to read the person's heart rhythm on the cardiac monitor.

Patch - to call ahead to the hospital and give a brief report on the patient that you are bringing in, so they have time to prepare.


	3. Chapter 3

_"Hopefully she won't drive like a moron._" Satsuki thought, as Ryuuko pulled the truck out of the patient's driveway and began down the road. It was important that the patient not be jostled, because the obstruction in the patient's trachea could shift any time and become a full obstruction.

"So it's going to be about a 10 minute drive, Susan. You are doing really well; I know that this is really scary and uncomfortable for you. We're just going to keep staying nice and still, and when we get to the hospital they will be able to remove the steak." Satsuki said, keeping her voice calm and light and with a soothing smile on her face. Susan nodded gratefully, her mouth still gaping open with her head raised as she tried to compensate for the lack of airflow she was receiving.

_ "Sats are still 96% on oxygen, her dyspnea or level of distress hasn't really changed. I'm starting to hear mucous gurgling on inspiration and expiration; it's probably building up on top of the obstruction. Face is still flushed, but no cyanosis. Let's put an end tidal on her, I want to know what her carbon dioxide levels are at." _Satsuki evaluated mentally, reaching for the pouch at the back of the monitor to pull out a coil of what looked like clear tubing.

"Susan, I'm just going to take off the oxygen for a second and put this on, it hooks behind your ears and sits just under your nose. It will feel a little uncomfortable, but it measures your carbon dioxide levels and gives me more information about your breathing, okay?" the woman nodded her consent, and Satsuki hooked the end tidal on her appropriately. She placed the oxygen mask back on her over top of the tubing, and screwed the end of the tube into the monitor. After a slight delay, an orange waveform appeared on the monitor with numbers beside it.

_"Okay. Her resp rate is 35 – a little high but she compensating well. Her CO2 level is 38, a little up there so she is having difficulty expelling air properly. Not a problem here in the pre-hospital setting, but something that the ER should know." _The carbon dioxide could build up to the point where the pH level of the patient will actually change – and the patient will become more acidotic. The body's natural response would be to increase respirations to expel the excess carbon dioxide and return the pH to normal, but with an airway obstruction that would only serve to make the patient feel more short of breath and anxious.

"I'm going to take another listen to your lungs, okay? Just breathe normally for me." Satsuki said, hooking her stethoscope back into her ears. _"No doubt about it, the gurgling is worse. The mucous is really building up… how far are we from the hospital?" _Satsuki glanced out the back doors as she pulled her stethoscope off, working to keep her concern off her face. _"Good, we just got on the highway. Only 5 minutes to go."_

The patient shifted suddenly, a loud wet sound coming from her mouth. Her chest heaved as she tried to compensate for the mucous she just sucked in, desperately trying to stifle her cough. Suddenly, there was an absence of noise. The patient's eyes widened, and sheer panic took hold as she couldn't take a breath in or out. She began to thrash on the stretcher, chest heaving as she desperately tried to expel the obstruction but couldn't. Her hands grabbed desperately at Satsuki.

"I need you back here, Ryuuko. It's a full obstruction." Satsuki called to the front, fighting down the panic that threatened to take hold. She took a deep breath, and let her training take over.

"This is going to hurt." She warned, lowering the back of the stretcher down and standing over the patient's chest. She tried not to look at the patient's face as she pressed down hard on the patient's chest, hearing a large crack as the patient's ribs broke. The woman clawed at Satsuki's hands desperately, fingertips turning blue. Beside her, the monitor beeped a warning as the oxygen saturation levels dropped. Satsuki determinedly kept pumping on the woman's chest, hoping that the CPR would provide the pressure needed to forcibly expel the obstruction.

"I'm here, I'm here." Ryuuko panted, climbing into the side door.

"Check the airway." Satsuki ordered. She kept pumping as Ryuuko tore off the NRB and end tidal, and rolled the patients head backwards to open the airway and peer inside.

"I've got nothing." Ryuuko said, tearing into the oxygen bag and pulling out the bag-valve-mask to prepare for the resuscitation. Satsuki huffed in frustration, acutely aware that the woman's hands had begun to spasm, forearms curling in towards her chest as her oxygen starved brain made a last ditch effort to protect itself.

"She's going decorticate. Switch with me while I get the pads on." Satsuki said, shuffling over to make room for the girl in the cramped space. Ryuuko took over compressions, and Satsuki quickly unzipped the side pouch of the monitor and opened the packaging for the defibrillation pads. She pulled her shears off the pouch on her duty belt, and cut the woman's shirt up to the collar to fully expose the woman's chest. She peeled the first pad, and Ryuuko lifted her hands for a moment to allow Satsuki to place the pad on the right side of the woman's chest. Satsuki peeled the second pad and placed it in the appropriate position on the woman's left side.

"Pulse check." Satsuki barked, and Ryuuko immediately placed her fingers on the woman's carotid. A slight pause, then Ryuuko stated "She's VSA."

"Alright. I'm analyzing." Satsuki warned. Ryuuko shifted back, careful not to touch the patient. Satsuki studied the monitor for a second.

"She's in v-tach. I'm charging."

_"Alright. One shock, check the airway to see if the obstruction relieved itself, then let's get the hell going."_

"Shocking. Clear!" Satsuki said, her eyes sweeping over the patient to make sure that Ryuuko wasn't touching her. The woman jolted as she hit the button, and Satsuki watched as the monitor displayed a normal rhythm for a moment before becoming erratic again. She turned to ask Ryuuko to check the airway, but Ryuuko was already on it.

"I see it!" the girl crowed. She swept her fingers into the woman's mouth, brows furrowed as she concentrated. "I just can't get it out." She grunted.

"Let me try." Satsuki said. Ryuuko moved over to make room for her. Satsuki could see the grey piece of meat right at the back of the woman's throat, too slippery for her to properly grip with her fingers and pull it out. "Dammit." She huffed. "Get me the forceps." The buzz of the truck suction sounded beside her.

"Let me try something." Ryuuko said, elbowing her out of the way with clear suction tubing in hand. Satsuki allowed herself to be moved, eyes widening as she realized what Ryuuko was doing. _"She took the suction tip off the tubing, and is using the wider hole to increase the surface area with the suction to try and pull it out. Clever girl."_

Satsuki pumped the woman's chest, and with their combined effort Ryuuko was able to pull the meat out. "Got it!" she said. Satsuki watched as the girl confidently pulled the woman's head back again and pressed the BVM to the woman's face. She squeezed the bag, forcing pure oxygen into the woman's lungs quickly for about thirty seconds. Satsuki eyed the monitor as she pumped the woman's chest, then down to her watch.

"15 seconds left until our next analyze." She grunted, feeling a bead of sweat drip down the back of her neck.

"Gotcha." Ryuuko affirmed, pausing in her ventilations for a second to place a plastic shunt into the woman's mouth, which would help keep the airway open. Satsuki kept giving compressions until the two minutes were up. "Analyzing." She grunted.

_"V-tach again. Perfect. Now she has oxygen in her system, maybe she will stabilize."_

"V-Tach. Charging." Satsuki huffed, making sure that Ryuuko stepped back. The monitor rang at her, indicating it had charged up to 300 joules. "Clear!"

The woman jolted for the second time, and Satsuki watched the monitor with baited breath. "Sinus tach again. We got a ROSC. Let's get going again, just give me a minute to put in a King. Are you okay to patch from the front?" Satsuki asked, rooting through the bag for the advanced airway. Ryuuko hyperventilated the patient for a moment until Satsuki had all the equipment ready.

"Yeah, I'm good. I'll get that patch right away." She said, and exited through the side door.

Satsuki hummed in approval, her fingers deftly coating the plastic tube with lube before inserting it into the patient's mouth. She quickly inflated the balloon at the bottom of the tube with the large syringe, and with a tug the airway was secure in place. She quickly hooked up the BVM to the end of the tube and squeezed the bag with one hand, listening with her stethoscope with the other. "_Air entry bilaterally, but nothing epigastric. Good."_ The King airway was in the correct place, the end of the tube deep in the patient's throat. A small balloon at the end closed off the opening to the esophagus while providing a clear path for the air to enter the trachea and go to the lungs. If she had heard air movement in the epigastric region, where the esophagus meets the stomach, that meant the air was entering the stomach instead and the patient would soon vomit violently. Not good when you have a plastic tube jammed down your throat. Satsuki quickly secured the end of the airway in place with a tube tie, so she wouldn't inadvertently knock the airway out of place and have to reinsert it.

"We're good to go, Ryuuko!" Satsuki called, ventilating the patient every five seconds as Ryuuko pulled back onto the highway with sirens blaring.

* * *

Ryuuko wiped the sweat off her brow as she accelerated smoothly up to 130km/hour. "_Jesus Christ, that was intense."_ she thought with a tired grin. She reached for the radio.

"Honno, call 2115"

"Go ahead, 2115" dispatch responded.

"We are good to go for that patch now."

"10-4 15, stand by."

Ryuuko formulated what she was going to say while she waited for the hospital to come on the line.

"Honno General ER, on the line." A female voice stated.

"Honno General, this is 2115 coming to you on a priority one with a ROSC." Ryuuko began. "We have a female patient, 45 years of age. Patient initially had a partial airway obstruction, which evolved to a full obstruction while en route. We were able to clear the obstruction, and shocked twice. Patient is currently in a Sinus Tach but still in respiratory arrest, we are ventilating with a secured airway and our ETA is approximately 5 minutes. We do not have IV. So again, we are coming in with a ROSC, the obstruction has been fully cleared, and patient is currently in respiratory arrest; over."

"10-4, see you in Emerge." The woman's tired voice responded. Ryuuko hung up the radio and switched lanes, slowing the vehicle as she approached the off ramp. The drive continued without incident, and they pulled into the garage of the hospital a couple minutes later.

Ryuuko exited the vehicle, walking quickly to the back of the truck. Two medics from a different crew already had the back doors open, and were pulling out the stretcher as Satsuki continued ventilations. Ryuuko let the crew take the stretcher, using her fob to open the doors for them as Satsuki walked briskly alongside the stretcher squeezing the BVM. Together they wheeled the patient into one of the resuscitation rooms, and Ryuuko helped transfer the patient onto the bed and unhooked her from all their cords and wires. As quick as she could remove their pads and equipment, nurses were putting their equipment on. As she worked, she heard Satsuki smoothly giving the report to the doctor, rattling off the events that occurred and their last set of vitals.

"Well done, you two. We will take over from here." The doctor said. Satsuki tapped Ryuuko on the shoulder as she watched the nurses work, indicating that it was time to go. Together, they walked out of the resuscitation room and in the hallway.

Ryuuko caught Satsuki's eye with a grin. Satsuki snorted. "You newbies." She grumbled halfheartedly. "Walking on sunshine after every hot call."

"Hey now." Ryuuko yelped with a grin. "I only had one VSA while on consolidation, can you really blame me? That was unreal."

Satsuki stopped, and looked Ryuuko in the eye. "You did great today." She said. "That trick with the suction tubing, it didn't even cross my mind to try that. That was fantastic."

Ryuuko hummed embarrassingly, feeling her face burn at the praise. She turned to grab the stretcher and begin wheeling it out to the bay. "Well, you were amazing too. The way you managed that, it was so smooth. I was just driving, you did all the hard work."

"But I wouldn't have been able to do it alone. You kept up with the call perfectly, and didn't let yourself get distracted or panicked. Especially considering that was your first call as a medic… that is something to be proud of." Satsuki said simply, falling in place at the back of the stretcher to push while Ryuuko steered.

"Crazy though, that call. Especially since you started compressions while she was still alive. I know that's the standard with an airway obstruction, but man that must have felt unnatural."

If Ryuuko had looked behind her, she would have seen Satsuki's face darken at the memory of the woman clawing at her hands while she broke her ribs. "It was…disturbing." Satsuki admitted. "But that's the nature of this job. Sometimes you have to do what needs to be done, regardless of whether it hurts the patient."

Ryuuko stopped in front of the cleaning station, and evaluated her partner's expression. "Are you okay?"

Satsuki forced her brows to unfurrow, and her posture to relax. She let out a long breath, then looked at Ryuuko with a small smile. "I'm fine." She said. "But let's hurry and get this truck cleaned up, because I'll feel a lot better with a coffee."

Ryuuko grabbed them some cleaning wipes.

* * *

**AN:** Whew. I know that was a little wordy. Is my guide here at the end of each chapter enough for you to be able to keep up? I would love some feedback on the matter.

Dyspnea – term for having irregular/difficulty breathing. To stop breathing entirely is called "apnea"

Cyanosis – bluing of the lips and fingers. A sign of oxygen deprivation.

End tidal – a device that measures the amount of carbon dioxide the patient is expelling. Looks similar to a nasal cannula, and it hooks around the ears and sits just under the nose just like one. Also called "capnography"

Resp rate – number of breaths per minute.

BVM – bag valve mask. A oxygen device that forces air into the patient's lungs when they aren't breathing on their own. Also called an AMBU bag in some places.

Decorticate – a spasm of the arms that curls the patient's arms up towards their chest. A last ditch effort from the brain to try and protect itself.

Carotid – the pulse on a patient's neck

V-Tach – ventricular tachycardia. An irregular rhythm of the heart where it is beating so rapidly that no circulation is occurring. One of the two rhythms that can be shocked with a defibrillator, the shock momentarily stops the heart and (in theory) resets back to a normal rhythm. In this case, the patient rapidly progressed back into this rhythm after the first shock because the heart was starved for oxygen and couldn't keep normal function

King – King LT. A advanced airway that provides a better path for oxygen flow to the lungs. Not as good as intubating the patient, but only ALS crews can intubate.

Epigastric – the region where your esophagus meets your stomach.

Esophagus – the tube that leads to your stomach

Trachea – the tube that leads to your lungs. This patient's obstruction was in the trachea.


	4. Chapter 4

The rest of the shift went by uneventfully, the two only having a handful of low priority calls with plenty of coffee breaks in between.

"I think I'm going into V-Tach." Ryuuko groaned as she mopped the back of the truck before the night crew arrived for their shift. Satsuki snorted as she changed the tank on the portable oxygen.

"You didn't have to get coffee every time we stopped. Or you could switch to tea, like I do in the afternoon." Satsuki said, her fingers deftly screwing the regulator on the tank back into place.

"But coffee is so good!"

"Not four times a day!"

Their banter had been flowing easily all afternoon. In a good mood, Ryuuko put the mop away and sauntered to the crew room with a whistle to log out of her shift. As the sounds of her partner faded away Satsuki let a content smile spread across her face, secretly pleased with how things had played out. The girl seemed to know her stuff, and was clever with how she utilized her equipment on calls. Ryuuko was also genuinely kind and understanding with patients, especially with the elderly. But she seemed to have a wild streak that would serve her well with handling drunks and other difficult customers.

"And she's beautiful." A small voice said in the back of her head, but Satsuki ignored it. She generally always ignored that voice.

"Yo, Satsuki!" Uzu called out in greeting as he walked into the garage, Ira behind him. When he reached the back of the truck, he stopped in his tracks with exaggerated shock.

"Whoa! Look at that smile! I don't think I've ever seen you so happy."

Satsuki wiped the grin off her face. "It was a good day until about 10 seconds ago." She retorted, somewhat embarrassedly. Uzu groaned with mock pain, but luckily dropped the subject.

"So how's the newbie coming along?" Ira asked, as the two of them dropped their bags off in the truck.

Satsuki paused, considering what to say. "It's a little early to tell, but she impressed me today." She said finally. She was reluctant to build the girl up to other medics just yet, because one shift was hardly enough time to make any kind of judgement on the quality of medic Ryuuko would become. But Satsuki instinctively had a feeling that Ryuuko would be great, and her instinct had served her well so far.

Uzu gave a low whistle. "She's that good eh? I'm glad to hear it. It seems like the quality of students has been decreasing lately."

Satsuki gave a noncommittal hum of agreement, fetching her bag from the front of the truck and grabbing Ryuuko's as well. She wished the night crew a good shift, and once the standard pleasantries were exchanged she left the garage and met Ryuuko in the crew room.

"I finished the end of shift duties, all that's left for you to do is clock out." Ryuuko said.

"That's great, thank you. I grabbed your bag for you." Satsuki said, placing the bag on the table before sitting down at the computer. In the corner of her eye she saw Ryuuko hesitate, shifting her weight awkwardly.

"You're okay to leave, go get a good night's rest." Satsuki said, not looking away from the monitor.

Ryuuko laughed, scratching the back of her head. "Yeah, I think I will. I'm pretty beat. But Satsuki," Ryuuko's voice trailed off, prompting Satsuki to turn and look at her partner.

"Thanks, I guess." Ryuuko said, blushing slightly. "I'm glad that we are partners, I know it's only been one shift but I think we work well together."

That small voice in the back of her mind wondered briefly if this girl could get any more adorable.

"I agree." Satsuki said neutrally, trying to feign that Ryuuko's words didn't actually touch her. "I think that these few months are going to go really well. As long as you keep up the effort and quick thinking that you displayed today."

"Thanks." Ryuuko coughed. "Anyways, I'm going to go. I'll see you in the morning."

Satsuki smiled and responded, but as the girl left the room her smile disappeared and she huffed tiredly to herself.

"_What is wrong with me?" _she wondered briefly.

* * *

Ryuuko opened the door to the apartment she shared with her roommate. "Ahh, it smells so good!" she groaned.

"In the kitchen!" Mako called, and the distinct sound of frying filled the room. Ryuuko grinned, kicking off her boots at the door.

"Croquettes? What's the occasion?" she teased, hugging Mako from behind in greeting. Mako hummed in response, before pulling away to raise the batch of croquettes out of the fryer. "To celebrate your first shift as a paramedic, duh!" she said, tipping the wire basket onto a plate and placing it on the kitchen table behind her. Ryuuko sat down in her chair with a sigh.

"You're a better friend than I deserve, Mako." She said wistfully, pouring herself a glass of milk.

"I know." Mako said with a grin, placing two bowls of rice on the table before sitting down herself. "So how was it?"

"Great!" Ryuuko managed with a mouth full of croquette. She swallowed and continued. "We had a VSA right off the bat, and my partner is awesome."

"A girl?" Mako prompted through a mouth full of rice.

Ryuuko nodded. "Satsuki Kiruu-something. She's only a year older than me, but she's been a medic for like six years. She amazing, totally smart, good with patients, beautiful…" she cut her rambling off when she saw the look on her friend's face. "What?" she snapped defensively.

"Nothing." Mako hummed with a knowing look, finishing her plate and reaching for more. "I'm just happy for you."

"It better be nothing." She grumbled halfheartedly as she took another bite.

* * *

Satsuki unlocked the door to the house, tiredly dropping her bag by the door and unlacing her boots. She straightened up and pulled the elastic out of her hair, her fingers coming through the braid until her hair cascaded freely down her back. A small grumble in her stomach reminded her that she still hadn't eaten supper, and her mind had been so occupied on the drive home that she had forgotten to stop and pick up food.

She walked to the kitchen and opened the fridge, sighing as she examined the contents inside. "I should have gotten groceries the other day." She muttered to herself, closing the fridge door. She glanced at the clock on the microwave. Nonon was due home from work in about half an hour.

"Chinese it is, then." She said to no one in particular, rooting through a drawer of papers for the well worn menu of their favourite Chinese place. She ordered enough food to last a couple days, including enough of Nonon's favourites to hopefully keep her from complaining about having Chinese for the third time in two weeks.

Having taken care of the food situation, Satsuki went to the basement. She stripped out of her uniform, throwing the set into the washer along with several other uniform garments that she had been putting off washing. She ignored the pile of normal clothing that sat on the floor beside the uniforms, preferring not to contaminate her civilian clothes with the dirt and God-knows-what-else from her work wear. After setting the temperature to hot, Satsuki stepped into the shower.

She stood under the hot stream of water, allowing her mind to drift as she methodically shampooed and rinsed her hair.

Satsuki realized suddenly that she had been daydreaming of Ryuuko, and had been for the past 15 minutes. "This is silly." She told herself, her palm pressed against her forehead. "She's just another new-hire." She couldn't understand why something inside her was urging her to become better friends with the girl, to want to spend time with her. It was like nothing she had experienced before.

She turned the shower off and stepped out, shivering as the cold air hit her wet skin. As she towelled off she heard the floor creak above her. Nonon was home.

"Satsuki-chan?"

"Be out in a minute!" she called. She pulled on an old t-shirt and flannel pajama bottoms, towelling her hair as she made her way up the stairs.

"Hey, Nonon." She said.

The tiny pink-haired girl huffed at her in disapproval, one hand on her hip. "I thought you said that you were going to get groceries on your way home? We're out of food." She grumbled.

Satsuki froze. "Ah, right." She said uncertainly. "About that…"

The doorbell rang.

"I took care of it." She said brightly, walking over to answer the door. Nonon sighed, sitting down on the couch and flicking on the tv.

"Tell me that it's not Chinese again." Nonon called over her shoulder as she scrolled through the channels, looking for something to watch. The delivery guy rose an inquisitive eyebrow at Satsuki. She sighed, giving him an apologetic smile and an extra tip.

"Okay, it's not Chinese." She said neutrally as she closed the door with bags in hand.

"You fucking liar." Nonon groaned when Satsuki set the bags on the coffee table. They settled on the couch with chopsticks in hand, watching a re-run of Chicago Fire while Nonon chatted idly between bites.

"What is it with television shows and making firefighters look so damn attractive? All the fire I've met through you are hideous." Nonon lamented through a mouthful of vegetable fried rice.

"Not sure." Satsuki said distractedly, not paying much attention to anything besides her own thoughts.

Nonon put down her food. "Okay, what's going on?" Satsuki internally cursed her friend for being so perceptive.

"What do you mean?"

"I mean that you've never been so quiet while watching this show with me before. Dawson and Shae just backboarded a patient and didn't use headblocks again. Normally you would be all over that, and complain about what garbage this show is the whole way through. What's going on? Did you have a rough call or something?"

Satsuki sighed. "No, nothing like that. I mean, we had a VSA right at the start of shift, but it was nothing bad."

Nonon snapped her fingers. "You were with that new girl today, right? Is that it?"

Another sigh. "Okay, maybe."

Nonon huffed, picking up her food again. "Well, if she's that bad, you need to tell a supervisor. There's no need to put your career at risk for some idiot."

Satsuki shook her head. "No, it's nothing like that. Ryuuko is actually good. Really good. She actually blew me away on that VSA, she had this trick with the suction and relieved the airway obstruction when I couldn't."

Nonon raised a brow. "So what has you so worried, then?"

She shrugged. "I…don't know. I guess I'm just looking forwards to working with her. I think the potential is there for us to be really close."

"What makes you say that?"

Satsuki opened her mouth to answer, and shut it again when she had no response. Why did she feel that way? There was no obvious explanation, just that inexplicable draw she felt when she thought of the girl. "I'm not sure. It's just a gut feeling that I have." She said vaguely.

Nonon had a strange expression on her face. She was staring at Satsuki, a look of intense concern and worry pinching her features. Satsuki had only seen that particular expression a handful of times since she met the girl. "What's wrong?" she asked.

Nonon realized she had been staring, and smoothed her expression. "Nothing. I was just thinking of something else." She said, laughing awkwardly. "I'm glad that you and the girl are getting along. Can you pass me the sweet and sour pork?"

Satsuki passed her the carton, still wondering what had her oldest friend so worried.

* * *

**AN:** It took a while to figure out where I wanted to go with this story, because just regurgitating calls that I've had would get really boring really quickly. There will be a plot soon, I promise. Thanks for reading!


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